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NPI Code Detail

MEDICARE: HUMBLE EMERGENCY PHYSICAINS PROFESSIONAL ASSOCIATION

MEDICARE: HUMBLE EMERGENCY PHYSICAINS PROFESSIONAL ASSOCIATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1013930973
Entity Type Code : Organization
Provider Name (Legal Business Name) : HUMBLE EMERGENCY PHYSICAINS PROFESSIONAL ASSOCIATION
Provider Business Mailing Address
First Line : 18951 N MEMORIAL DR
Second Line :
City : HUMBLE
State : TX
Zip : 77338-4217
Country : US
Telephone Number : 281-540-6453
Fax Number : 281-540-7393
Provider Business Practice Location Address
First Line : 18951 N MEMORIAL DR
Second Line :
City : HUMBLE
State : TX
Zip : 77338-4217
Country : US
Telephone Number : 281-540-6453
Fax Number : 281-540-7393
Authorized Official
Title or Position : PRESIDENT
Name : DR. DAVID W. OLSON
Credential : M.D.
Telephone Number : 281-540-6453
Provider Enumeration Date : 07/25/2006
Last Update Date : 09/06/2007

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1790899953 — DR. CHRISTOPHER DANIEL FEDORUK MD
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Directions to “HUMBLE EMERGENCY PHYSICAINS PROFESSIONAL ASSOCIATION ” Practice Location

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